<!doctype html>
<html>
<head>
<meta charset="utf-8">
<title>无标题文档</title><style>
	.shouye a{text-decoration: none;}
	body{background-color: #E8E7E3;}
	</style>
</head>

<body >
<h1 class="shouye" align="left"><a href="shouye.html" >首页</a></h1>
	
<div class="wrapper">
<h1 align="center">密切接触者信息登记</h1>
  
  
    <div class="content-wrapper">

       
       

        <form action="/patient/addBase"
              method="post">
          
            <section class="content"> 

                <div class="panel panel-default">
                    <div class="panel-heading">基本信息</div>
                    <div class="row data-type">

                        <div class="col-md-2 title">姓名</div>
                        <div class="col-md-4 data">
                            <input type="text" class="form-control" name="name"
                                   placeholder="姓名" value="">
                        </div>
                        <div class="col-md-2 title">身份证号码</div>
                        <div class="col-md-4 data">
                            <input type="text" class="form-control" name="idCard"
                                   placeholder="身份证号码" onblur="IdentityCodeValid(this.value)" value="">
                        </div>
                        <div class="col-md-2 title">年龄</div>
                        <div class="col-md-4 data">
                            <input type="text" class="form-control" name="age"
                                   placeholder="年龄" value="">
                        </div>

                        <input type="text"  name="msg"
                               value="touch" hidden="">

                        <div class="col-md-2 title">性别</div>
                        <div class="col-md-4 data">
                        <select class="form-control select2" style="width: 100%"
                                name="gender">
                            <option value="男" selected="selected">男</option>
                            <option value="女">女</option>
                        </select>
                    </div>

                        <div class="col-md-2 title">地址</div>
                        <div class="col-md-4 data">
                            <input type="text" class="form-control" placeholder="地址"
                                   name="address" value="">
                        </div>
                        <div class="col-md-2 title">电话号码</div>
                        <div class="col-md-4 data">
                            <input type="text" class="form-control" placeholder="电话号码"
                                   name="phone" value="" onblur="validatemobile(this.value)">
                        </div>

                    </div>
                </div>
              
                <div class="box-tools text-center">
                 
                    <button type="button" 
                           ><a href="系统用户管理.html">返回</a></button>
                </div>
              </section>
           
        </form>
    </div>
   



</div>

</body>
</html>
